scholarly journals Healing below the ankle is possible in patients with diabetes mellitus and a forefoot gangrene

2021 ◽  
Vol 9 ◽  
pp. 205031212110291
Author(s):  
Targ Elgzyri ◽  
Jan Apelqvist ◽  
Eero Lindholm ◽  
Hedvig Örneholm ◽  
Magdalena Annersten Gershater
Keyword(s):  
Diabetic Foot ◽  
Clinical Characteristics ◽  
Foot Ulcer ◽  
Major Amputation ◽  
Severe Form ◽  
Foot Ulcers ◽  
Vascular Intervention ◽  
Co Morbidity ◽  
Patients With Diabetes

Background: Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods: Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3–234) weeks. Results: Four hundred and seventy-six patients were included. The median age was 73 (35–95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3–234) weeks; for auto-amputated, 48 (10–228) weeks; for minor amputated, 48 (6–234) weeks; and for major amputation, 32 (3–116) weeks. Conclusion: Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.

scholarly journals “ ASSESSMENT OF SEVERITY OF DIABETIC FOOT ULCERS USING DIABETIC ULCER SEVERITY SCORE.”

2020 ◽  
pp. 19-21
Author(s):  
Aarushi Mishra ◽  
Anilkumar P. Bellad ◽  
M.I. Uppin
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Severity Score ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Diabetic Ulcer ◽  
The Past

INTRODUCTION : Diabetes mellitus is a common metabolic disorder, prevalence steadily increasing over the past few decades. The complications associated with it , hence , has also increased. Diabetic foot ulcer is one of the most serious complications , utilizing resources, significantly contributing to the morbidity of the patient. There is hence, a need to correctly identify the severity of the diabetic foot ulcer so as to plan the appropriate management and to help in counselling of such patients. AIM : To assess severity in diabetic foot ulcer using diabetic ulcer severity score. MATERIAL AND METHODOLOGY : This is a hospital based longitudinal study , conducted on 93 study subjects admitted with diabetic foot ulcers. Diabetic ulcer severity score was calculated for each patient . The score was calculated by adding scores of the respective parameters constituting site of ulcer, number of ulcers, presence/absence of pedal pulsations, presence/ absence of bone involvement. Each patient was followed up for a period of 6 months , or earlier in case of patient undergoing minor/major amputation. After the study was conducted , analysis was done by calculating various percentages of healing /amputation with respect to the score. RESULTS : Out of the total 93 study subjects , 74.2% were males. The mean age was calculated to be 59.6 years with maximum number of subjects being in 55-60 years of age group range. Majority of them had diabetic ulcer severity score of 2 (42%). Out of the total study subjects , 58% had a complete healing , 28% underwent minor amputation whereas 14% underwent major amputation. 100% of the study participants with score 0 had healing of ulcer which decreased to 85% for score 1 , 53.8% for score 2 , 6.25% for score 3 and 0% for score 4. This was suggestive of poorer chances of healing as the diabetic ulcer severity score increases. CONCLUSION : With the increasing incidence of patients diagnosed with diabetes mellitus , the rate of complications of diabetes has also increased over the past few decades including the risk and occurence of diabetic foot ulcers There is an increasing need for diabetic foot ulcer prognostication systems and universal use of the same. Thus ,we recommend the use of diabetic ulcer severity score as a prognostic tool to assess the severity of the diabetic foot which will further enhance communication and counselling of the patient and will help in providing the appropriate treatment to such patients.

scholarly journals A clinicopathogical study on diabetic foot ulcer with special reference to the causative factors and its management

2019 ◽  
Vol 6 (5) ◽  
pp. 1540
Author(s):  
Sailendranath Paul ◽  
Dilip Kumar Das
Keyword(s):  
Diabetic Foot ◽  
Age Of Onset ◽  
Management Strategies ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
E Coli ◽  
Related Risk

Background: Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. The present study was done to identify the incidence and related risk factors of diabetic foot ulcers in study participants.Methods: This was a prospective done on 50 patients with diabetic foot ulcers. All the patients were examined thoroughly and related laboratory investigations were done. Wound culture and sensitivity was done in all cases.Results: Mean age of onset with foot ulcers was 53.5 yrs in male and 55 yrs in females. Nephropathy was present in 12 (24%) patients. Sensorimotor neuropathy was present in 29 (58%) cases and autonomic neuropathy was present in 06 (12%) cases. Most common infection identified in diabetic foot ulcers was due to gram-negative bacteria (E. coli in 45 cases). Major amputation was done in 2 (4%) patients.Conclusions: Implementation of management strategies at early stages prevents the development of complications related to diabetic foot ulcers in patients. 

scholarly journals Drugs abuse and increase in referral to hospital to prevent recurrence of diabetic foot ulcer infection

2019 ◽  
Vol 10 (1) ◽  
pp. 89-94
Author(s):  
Mostafa Madmoli ◽  
Yaghoob Madmoli ◽  
Fariba Mobarez ◽  
Hosein Taqvaeinasab ◽  
Pouriya Darabiyan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Drug Abuse ◽  
Significant Relationship ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Patients With Diabetes ◽  
History Of

Introduction: Diabetic foot ulcer is one of the complications of diabetes. This study was aimed to determine drugs abuse and increase in referral to hospital to prevent recurrence of diabetic foot ulcer infection. Materials and Methods: In this retrospective cross-sectional analytical descriptive study, 1693 patients with diabetes between 2015-17 were enrolled. Files of this number of diabetic patients admitted to khatam-ol-Anbia hospital in shoushtar city were studied. Data were entered into SPSS software version 18 and analyzed using descriptive statistics, analytical tests. Results: In this study 1693 patients with diabetes mellitus with a mean age of 52.13 ± 53.22 years. In the case of diabetic foot ulcers, 9.5% of the patients had diabetic foot ulcers and 4.8% had a history of amputation and 2.4% of the patients had a history of surgery on their diabetic ulcer. In this study, a significant relationship was found between education level and diabetic foot ulcer (p <0.003). Also, there was a significant relationship between limb amputation and drug abuse or smoking (P = 0.009). In this study, patients who had drug and smoking or smoking 4.3% more than those who did not consume, they were referred to the hospital to prevent recurrence of foot ulcer infection. In this study, there was a significant relationship between drug abuse or smoking and the rate of surgery in diabetes mellitus (P = 0.007). Conclusion: Given that in this study, patients who had drug and smoking or smoking 4.3% more than those who did not consume, they were referred to the hospital to prevent recurrence of foot ulcer infection. In this study, there was a significant relationship between drug abuse or smoking and the rate of surgery in diabetes mellitus. Therefore, there is a suggestion to reduce the consumption or abandonment of drugs and smoking.  

scholarly journals Diabetic foot ulcer management in a multidisciplinary foot centre: one-year healing, amputation and mortality rate

2020 ◽  
Vol 29 (8) ◽  
pp. 464-471
Author(s):  
Georges Ha Van ◽  
Chloe Amouyal ◽  
Olivier Bourron ◽  
Carole Aubert ◽  
Aurelie Carlier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Median Duration ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Major Amputation ◽  
Minor Amputation ◽  
One Year

Objective: To describe the rates of healing, major amputation and mortality after 12 months in patients with a new diabetic foot ulcer (DFU) and their care in a French diabetic foot service (DFS). Method: A prospective single-centre study including patients from March 2009 to December 2010. The length of time to healing, minor amputation, major amputation and mortality rate after inclusion were analysed using the Kaplan–Meier method. Results: Some 347 patients were included (3% lost to follow-up), with a median follow-up (IQR) of 19 (12–24) months. The mean (SD) age was 65±12 years, 68% were male, and the median duration of the ulcer was 49 (19–120) days. Complications of the DFU were ischaemia (70%), infection (55%) and osteomyelitis (47%). Of the patients, 50% were inpatients in the DFS at inclusion (median duration of hospitalisation 26 (15–41) days). The rate of healing at one year was 67% (95% confidence interval (CI): 61–72); of major amputation 10% (95% CI: 7–17); of minor amputation 19% (95% CI: 14–25), and the death rate was 9% (95% CI: 7–13). Using an adjusted hazard ratio, the predictive factors of healing were perfusion and the area of the wound. The risk factors for a major amputation were active smoking and osteomyelitis. The risk factors for mortality were perfusion and age. Conclusion: This study confirms the need to treat DFUs rapidly, in a multidisciplinary DFS.

scholarly journals Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer development

2012 ◽  
Vol 167 (3) ◽  
pp. 401-407 ◽  
Author(s):  
M Monteiro-Soares ◽  
A Vaz-Carneiro ◽  
S Sampaio ◽  
M Dinis-Ribeiro
Keyword(s):  
Diabetic Foot ◽  
Predictive Value ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Receiver Operating Curve ◽  
Predictive Variables ◽  
Patients With Diabetes ◽  
Good Diagnostic Accuracy ◽  
Diabetic Foot Screening

Aims/hypothesisThere are five systems to stratify the risk for the development of a diabetic foot ulcer (DFU). This study aimed to prospectively validate all of them in the same cohort of participants to allow their direct comparison.MethodsA retrospective cohort study was conducted on all patients with diabetes but without an active DFU attending our podiatry section (n=364) from January 2008 to December 2010. Participants' characteristics and all variables composing the stratification systems were assessed at baseline. Follow-up was performed for 1 year or until DFU occurred.ResultsParticipants had a mean age of 64 years; 99.7% had type 2 diabetes and 48.6% were male. Median follow-up was 12 months (1–12) during which 33 subjects (9.1%) developed a DFU. Age, diabetes duration, foot deformity, peripheral vascular disease, diabetic peripheral neuropathy, previous DFU, and previous lower extremity amputation were associated with DFU occurrence. All systems presented greater DFU occurrence frequency as the risk group was higher (χ2,P<0.001) and showed good diagnostic accuracy values, especially negative predictive value (≥95%) and area under the receiver operating curve (≥0.73). The lowest performance concerned positive predictive value (≤29.5%).Conclusions/interpretationAll the currently available stratification systems show high accuracy to detect which patients will develop a DFU with no significant differences among them. Therefore, for diabetic foot screening and resource allocation, it would be desirable to have a single unified system, combining the available systems, prospectively validated in a multicenter context and testing the inclusion of novel predictive variables' pertinence.

scholarly journals Diabetic foot ulcer management in a multidisciplinary foot centre: one-year healing, amputation and mortality rate

2021 ◽  
Vol 30 (Sup6) ◽  
pp. S34-S41
Author(s):  
Georges Ha Van ◽  
Chloe Amouyal ◽  
Olivier Bourron ◽  
Carole Aubert ◽  
Aurelie Carlier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Median Duration ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Major Amputation ◽  
Minor Amputation ◽  
One Year

Objective: To describe the rates of healing, major amputation and mortality after 12 months in patients with a new diabetic foot ulcer (DFU) and their care in a French diabetic foot service (DFS). Method: A prospective single-centre study including patients from March 2009 to December 2010. The length of time to healing, minor amputation, major amputation and mortality rate after inclusion were analysed using the Kaplan–Meier method. Results: Some 347 patients were included (3% lost to follow-up), with a median follow-up (IQR) of 19 (12–24) months. The mean (SD) age was 65±12 years, 68% were male, and the median duration of the ulcer was 49 (19–120) days. Complications of the DFU were ischaemia (70%), infection (55%) and osteomyelitis (47%). Of the patients, 50% were inpatients in the DFS at inclusion (median duration of hospitalisation 26 (15–41) days). The rate of healing at one year was 67% (95% confidence interval (CI): 61–72); of major amputation 10% (95% CI: 7–17); of minor amputation 19% (95% CI: 14–25), and the death rate was 9% (95% CI: 7–13). Using an adjusted hazard ratio, the predictive factors of healing were perfusion and the area of the wound. The risk factors for a major amputation were active smoking and osteomyelitis. The risk factors for mortality were perfusion and age. Conclusion: This study confirms the need to treat DFUs rapidly, in a multidisciplinary DFS.

scholarly journals Risk Factors for Diabetic Foot Ulcers in Metreleptin Naïve Patients With Lipodystrophy

2021 ◽  
Author(s):  
Onur Saydam ◽  
Basak Ozgen Saydam ◽  
Suleyman Cem Adiyaman ◽  
Melda Sonmez Ince ◽  
Mehmet Ali Eren ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Partial Lipodystrophy ◽  
Factors Associated ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract AimPatients with lipodystrophy are at high risk for chronic complications of diabetes. Recently, we have reported 18 diabetic foot ulcer episodes in 9 subjects with lipodystrophy. This current study aims to determine risk factors associated with foot ulcer development in this rare disease population.MethodsNinety metreleptin naïve patients with diabetes registered in our national lipodystrophy database were included in this observational retrospective cohort study (9 with and 81 without foot ulcers).Results Patients with lipodystrophy developing foot ulcers had longer diabetes duration (p = 0.007), longer time since lipodystrophy diagnosis (p = 0.008), and higher HbA1c levels (p = 0.041). Insulin use was more prevalent (p = 0.003). The time from diagnosis of diabetes to first foot ulcer was shorter for patients with generalized lipodystrophy compared to partial lipodystrophy (p = 0.036). Retinopathy (p < 0.001), neuropathy (p < 0.001), peripheral artery disease (p = 0.001), and kidney failure (p = 0.003) were more commonly detected in patients with foot ulcers. Patients with foot ulcers tended to have lower leptin levels (p = 0.052). Multiple logistic regression estimated significant associations between foot ulcers and generalized lipodystrophy (OR: 40.81, 95%CI: 3.31 - 503.93, p = 0.004), long-term diabetes (≥ 15 years; OR: 27.07, 95%CI: 2.97 - 246.39, p = 0.003), and decreased eGFR (OR: 13.35, 95%CI: 1.96 - 90.67, p = 0.008).ConclusionOur study identified several clinical factors associated with foot ulceration among patients with lipodystrophy and diabetes. Preventive measures and effective treatment of metabolic consequences of lipodystrophy are essential to prevent the occurrence of foot ulcers in these high-risk individuals.

scholarly journals Case report on the use of a honey on diabetic foot ulcer patients

2018 ◽  
Vol 1 (1) ◽  
pp. 98-104
Author(s):  
Suriadi (Corresponding author) ◽  
Rhamdaniyati ◽  
Wuriani Sudirjo ◽  
Sukarni Ali ◽  
Arina Nurpiyanti ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Healing Process ◽  
Clinical Signs ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Improve Wound Healing ◽  
Surrounding Skin

This article describes four infected diabetic foot ulcer patients who were treated with honey dressing as fragmented therapy. Quantitative and qualitative descriptions of the ulcer-healing process were documented. All four ulcers showed positive wound contraction and reduction in size, and clinical signs of infection were absent at the end of the follow-up period. Moreover, surrounding skin maceration and trauma were absent in all wounds. Adequate moisture control was also achieved, evidenced by a healthy red granulating base and a thin layer of clear light exudate in all fours cases. These reports provide little evidence that the use of honey dressing is effective in combating wound infection. Honey dressing can be used to improve wound healing in chronic diabetic foot ulcers.

scholarly journals PO 18105 - Diabetic foot ulcer PEDIS III

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 13S
Author(s):  
Alexandre Leme Godoy dos Santos ◽  
Guilherme Honda ◽  
Priscila Rosalba ◽  
Rafael Barban Sposeto ◽  
Tulio Diniz Fernandes ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Chronic Osteomyelitis ◽  
Foot Ulcer ◽  
Surgical Debridement ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Bone Culture ◽  
Microbiological Profile ◽  
Neuropathic Foot

Introduction: Infectious agents are associated with amputation of the infected diabetic foot if not promptly treated. It is estimated that 25% of patients with diabetes will present with a foot ulcer at some point of their lives. Our hypothesis is that the microbiological profile isolated from chronic osteomyelitis (CO) secondary to neuropathic foot ulcers is different from the standard profile relayed in the literature. Objective: To determine the microbiological profile and antimicrobial susceptibility patterns of organisms isolated from chronic osteomyelitis (CO) secondary to neuropathic foot ulcers. Furthermore, we aimed to describe the clinical outcomes of 52 patients admitted to a referral diabetic foot center. Methods: Medical charts of 52 patients with clinically infected neuropathic foot ulcers between 2005 and 2013 were reviewed. Osteomyelitis was diagnosed based on suggestive changes on radiographs and magnetic resonance imaging (MRI), and confirmed with a microbiological exam. All cases were followed for at least six months. Only results of bone culture obtained at the time of surgical debridement following antisepsis were considered for microbiological characterization. Results: One hundred and eleven bacterial isolates were identified as causative agents of infection, with a mean 2.13 isolates per patient. There was a predominance of Gram-positive cocci (51%), followed by Gram-negative bacilli (GNB) (43%). The most prevalent agents were Staphylococcus aureus (18%), Enterococcus faecalis (18%) and coagulase-negative Staphylococci (CoNS) (14%). Among S. aureus isolates, the prevalence of methicillin resistance (MRSA) was 48%, and 77% CoNS were methicillin resistant (MRCoNS) with 100% susceptibility to sulfamethoxazole/trimethoprim (SMT/TMP). At 6-month follow-up, 75% of patients were in remission, without signs of infection, 23% of patients presented recurrence of infection, and 2% were lost to follow-up. Conclusion: In diabetic patients with chronic osteomyelitis secondary to neuropathic ulcers, S. aureus, E. faecalis and CoNS were the most frequent agents. The occurrence of MRSA and MRCoNS was high, but with 100% susceptibility to SMT/TMP. Extensive surgical debridement associated with prolonged antimicrobial therapy led to infection remission in 77% of patients after 6 months of follow-up.

scholarly journals Evaluation of two therapeutic patient education programs for prevention of diabetic foot ulcers

2018 ◽  
Vol 10 (1) ◽  
pp. 10201
Author(s):  
Claire Marchand ◽  
Aurore Margat ◽  
Carole Deccache ◽  
Georges Ha Van ◽  
Jocelyne M’Bemba ◽  
...  
Keyword(s):  
Patient Education ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Education Programs ◽  
Therapeutic Patient Education ◽  
Exact Test ◽  
Significant Difference ◽  
Patients With Diabetes

Objectives: The purpose of this study is to evaluate and compare the effects of two education programs on patients’ understanding of the disease, self-efficacy, locus of control, and application of prevention behaviors for foot ulcer. Methods: In four centers that manage patients with diabetes and grade 2 or 3 neuropathy, the first arm of patients (G1 = 53) participated in a “standard” program usually managed in each center, and those in the second arm (G2 = 56) in a “new” program. The patients completed four questionnaires at inclusion (T0) and six months after the education (T1). Occurrence of a new foot ulcer and care behaviors were collected at T1. Z-test was used to compare mean scores for each questionnaire and Fisher’s exact test for percentages (p = 0.05). Results: There was no significant difference between groups G1 and G2 in terms of scores for each questionnaire at T0 and T1. Group G2 showed a significant change in score between T0 and T1 for understanding the disease (p = 0.04) and prevention behaviors (p = 0.01). For the sample as a whole (n = 109), there was a significant improvement between T0 and T1 for two questionnaires: understanding of disease (p < 0.01) and declared prevention behaviors (p < 0.01). Patients who reported having relative to participate in care had a significantly higher mean score on prevention behaviors (p < 0.01). Twenty patients had developed one new ulcer since the education (20.2%). Conclusion: This study reinforces the importance of devoting time during education to patients’ understanding of the disease and involving relatives to improve foot ulcer prevention behaviors.

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